Nevada Health Information Exchange DRAFT Health Information Exchange .

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Nevada Health Information Exchange DRAFT Health Information Exchange Technology Solution RFP for Public Comment on March 8, 2013 is available online at:

NHIE HIE Solution Architect/Technical Director Proposed Job Description Key Functions: Leads the process of defining the vision, principles, and processes that guide the design and deployment of Health Information Exchange (HIE) services for the Nevada Statewide HIE System/Network per the State Health IT Strategic and Operational Plan. Directs and manages NHIE HIE technical development, implementation and maintenance. Works with NHIE HIE Vendor(s) Directs for the creation of an HIE infrastructure that defines the interrelationships between processes, information, HIE Vendor hosted services, and applications, and ensures adherence to the State HIE strategy. Ensures the proper maintenance of the overall Statewide HIE System/Network architecture and its ability to adapt to new technologies and changing needs. This includes supporting the selection and contracting of HIE services from HIE Vendors. Maintains ongoing relationship with contracted HIE Vendor(s) to ensure continuity of services and evolution of those services to meet NHIE customer and market demands. Responsibilities: Based a selected HIE Vendor products and services, develop and maintain the overall NHIE Solution Architecture across several levels/domains including: business, information, application, and infrastructure to facilitate the design and deployment of the Statewide HIE System/Network as well as the addition of new service offerings. Takes an active role in defining the NHIE Service Portfolio by translating market demands, HIE Vendor capabilities, and the NHIE mission into a services portfolio that can be offered to the Nevada health community. Monitor the evolution of HIE related standards for messaging, security, privacy/consent, and information management to ensure adherence to defined HIE standards while enabling continued adoption of HIE services across the State. Responsible for working with HIE Vendor(s) to establish and continually improve HIE IT efficiency and effectiveness in key topic areas such as: o Technology convergence o Application integration & optimization o Leveraging existing standardized computing and storage/data platforms o Project design improvement o Infrastructure simplification o Solution updates, version releases and patches o Business continuity and disaster recovery Defines and promotes the standards, guidelines, and principles that the NHIE team uses to make its technology decisions to minimize risk through high quality design and supported technology.

Works collaboratively with NHIE staff, HIE Vendor, and NHIE customers in integration, issue resolution, and workflow improvements. Maintains understanding of state and federal HIE regulations and works closely with resources representing state and federal exchanges. Serves as a lead resource to various NHIE projects. Promotes new technology-based capabilities or innovations throughout HIE solution based on industry standards and/or trends. Creates an HIE scorecard to report key metrics on HIE utilization, throughput, and data quality to provide stakeholders within the Nevada Statewide HIE System/Network. This includes support for ongoing performance monitoring and evaluation per NHIE policy, State mandates, and Federal requirements. Will require some on-call coverage responsibilities Consults with operational leadership, especially project areas to reduce risk through HIE design expertise and improved alignment of project decisions to accepted HIE architecture and standards. Earns a reputation of credibility with application and infrastructure groups in order to facilitate the successful adoption of HIE. Directs and coordinates work with NHIE staff and subcommittees Works with stakeholders of the Nevada Statewide HIE System/Network (including independent HIEs) and the Western States Consortium in development of strategies and approaches for increased HIE usage and adoption. Qualifications Required Qualifications: Bachelor’s or Master’s degree from an accredited college or university in information systems, engineering, health information management, health informatics, or a closely related field Minimum of 3 years Solution Architecture experience. Demonstrated prior experience in Health Information Technology (minimum of 2 years). Experience must include health solution definition (e.g., architecture), clinical integration in a heterogeneous systems environment; HIT vendor selection and management; data management; security; and system operations Technical proficiency in integration platforms. Ability to lead infrastructure, application, quality assurance, and business continuity professionals. Experience with conducting requirements analysis and creating information structures in support of design concepts. Able to articulate user experience and design principles to team members and clients. Excellent interpersonal, presentation, written communication, and facilitation skills including ability to create technical and user level documentation.

Organizational skills to facilitate a productive working environment with strong ability to prioritize and work on multiple tasks at the same time. Able to perform independent evaluation, selection, and application of standard techniques, procedures and criteria. Able to effectively work in a large, geographically diverse system. Experience with integration engine technology, HL7, other health messaging standard and services, IHE Profiles, Java and HTML transaction formats. Experience with implementing solutions that fully secure individually identifiable health information (IIHI). Desired Qualifications: Past history of successfully building social networks as resources to rapidly formulate solutions and resolve technical issues. Demonstrated experience working with representatives from State and Federal government, health IT leaders in industry, vendor user groups, and/or standards committees. Familiarity with Federal and State Health IT architecture requirements (e.g., eHealth Exchange/NwHIN). Advanced degree in health care policy, health information management, health informatics, public health, or a closely related field. Significant experience and proven track record of managing and rapidly implementing and deploying operational health systems. Compensation: Compensation will be market-based, corresponding to the experience level, credentials, and personal characteristics of the candidate and will include a competitive base salary along with a full range of employee benefits.

Nevada Health Information Exchange HIE Vendor Requirements NHIE Technology Subcommittee and NHIE Staff will need to confirm (one last time) the alignment of requirements from following before issuing to HIE Vendors: Sub-recipient SOW State HIT Plan Governance & Operations Document State of Nevada Department of Health and Human Services Office of Health Information Technology January, 2013 INITIAL DRAFT

Table of Contents 1. 2. Executive Summary . 1 1.1. Overview of State-wide HIE System Requirements .1 1.2. Overview of HIE Vendor Services .3 Background: NHIE Operational Framework . 4 2.1. Nevada HIE Vision . 4 2.2. Nevada HIE Mission Statement.4 2.3. Principles and Values that Guide NHIE Roles, Responsibilities, and Relationships . 4 2.4. The Nevada HIE Organization Landscape . 5 2.5. DHHS Director . 7 2.5.1. Scope of Responsibility .7 2.5.2. DHHS Director Responsibilities . 7 2.6. 2.6.1. Scope of Responsibility .9 2.6.2. Board Roles and Responsibilities . 9 2.6.3. (Sub)Committees and Workgroups.10 2.7. 3. NHIE Board of Directors (Governing Entity) . 9 NHIE Corporation (Governing Body) .12 2.7.1. Scope of Responsibility .12 2.7.2. NHIE Corporation Roles and Responsibilities.12 2.8. Certified Participant (CP).17 2.9. End User .17 Scope of Work .18 3.1. Core HIE Solution .19 3.1.1. General Requirements .21 3.1.2. Information Exchange and Transport Services .21 3.1.3. Consent Management .33 3.1.4. Privacy & Security Services . 36 3.1.5. Identity Management & Authentication .44 3.1.6. Authorized User Directory Management .46 3.1.7. Provider Directory Services . 49 3.1.8. Enterprise Master Patient Index Management .51 3.1.9. Record Locator Service (RLS) . 55 NHIE Request for Proposals - HIE Vendor i

3.1.10. HIE Data Services.56 3.1.11. Portal Services .59 3.2. Enterprise HIE Services (Optional) . 61 3.2.1. Business Relationship .61 3.2.2. Conceptual Requirements.61 3.3. System Implementation Services . 62 3.3.1. Solution Delivery .62 3.3.2. Project Management .63 3.3.3. HIE Integration Services .65 3.4. Hosting Services .68 3.4.1. Architecture and Security .68 3.4.2. Scalable Environment.68 3.4.3. Service Availability .68 3.4.4. Maintenance .69 3.4.5. Change Management .69 3.4.6. Systems Environments .69 3.4.7. NHIE Operations Management .70 3.4.8. Data Ownership .73 3.4.9. System and Data Transition . 73 3.4.10. Administrative Services .74 3.4.11. Data Management .75 3.4.12. Data Center .76 3.4.13. Hosting Service Level Agreement (SLA) .76 3.5. Administrative & Operational Support .77 3.5.1. HIE Performance Management.77 3.5.2. Nevada HIE Metrics .78 3.5.3. Training and Education .78 3.5.4. Help Desk and Technical Customer Support .79 3.5.5. HIE Staffing Support .80 3.6. Business Development Support .81 3.7. Outreach Services and Promotional Materials .82 3.7.1. Outreach Effort .82 3.7.2. Branded Promotional Materials .82 NHIE Request for Proposals - HIE Vendor ii

3.7.3. 3.8. Online Promotions .82 Value-added HIE Solutions .83 NHIE Request for Proposals - HIE Vendor iii

1. EXECUTIVE SUMMARY NHIE will award a contract to a HIE Vendor that will provide the software and services necessary to implement and operate the technical components required for the Nevada State-wide HIE system. To be successful, the HIE Vendor must provide a HIE platform and associated services that will: Support high quality, safe, and efficient health care services; Deliver HIE-based information services to all providers operating in the State including and especially Medicare and Medicaid providers who will be eligible for incentive payments; Ensure the privacy and security of personal health information, both stored and exchanged; Enable intra-state, inter-state and nationwide health information exchange; Provide for a centralized consumer/patient consent management capability; Facilitate two way exchanges of information between the health community and the State of Nevada departments and agencies supporting Nevadans’ health (e.g., DFHS of Medicaid care services; Public Health registries such as immunization, cancer; Secretary of State advanced directives); Support Meaningful Use requirements (Stages 1, 2, and 3); and Support the services and products called for as part of an overall NHIE business model that is financially viable and sustainable without state general funding. The following subsections address component strategies for the development of the Nevada state-wide HIE system. 1.1. OVERVIEW OF STATE-WIDE HIE SYSTEM REQUIREMENTS The envisioned Nevada state-wide HIE Network will be hybrid infrastructure model consisting of the NHIE run State-wide HIE System operating in partnership with HIE businesses that are or will operate within Nevada and neighboring states. This strategic approach enables commercial HIE/RHIO businesses to thrive within the state while the NHIE provides the “HIE of last resort” to ensure equal access to health information services for all residents and health consumers located in the State, and connectivity to the national HIE called eHealth Exchange (formerly NwHIN) to those HIE participants within the state requiring such connectivity for interstate interactions and with Federal Partners including Centers for Disease Control and Prevention (CDC), Indian Health Service (IHS), Veteran Affairs (VA), Social Security Administration (SSA), and the Department of Defense (DoD). The State-wide HIE System to be implemented by the HIE Vendor will be based on architecture that is open and utilizes standardized functions within a Service Oriented Architecture (SOA) framework that is compliant with industry standards as well as the State’s implementation of Medicaid Information Technology Architecture (MITA). For the State-wide HIE System, HIE Vendor will implement the core information services that will enable the delivery of ARRA objectives. NHIE Request for Proposals - HIE Vendor 1

The broad requirements the HIE Vendor must meet for the State-wide HIE System are described in Section 10 of the ONC approved State HIT Strategic and Operations Plan. Minimal elements of the Core Solution to be implemented by the HIE Vendor include: Master Patient Index that support patient identity and merge/split of patient records; Provider Directory (Facilities) services that enable master data management of facility information where care is being delivered to one or more patients; Provider Directory (Individual) services that enable master data management of information regarding individual care providers who are performing care for one or more patients; Access Control Services that automate policy and administrative rights that limit or control access to patient data (e.g., consent management); Centralize Consent Management Services that enable the Access Control Services to be made available to inter- and intra-state HIEs; Record Locator Services that enable search for retrieval of federated patient data; Terminology Engine that normalizes the incoming medical coding and terminology into consistent forms enabling semantic interoperability (i.e., consistent meaning of health information regardless of its source); Messaging and Interoperability Services that enable reliable and secure flow of information via standard messages that are implemented utilizing open interoperability standards and follow interoperability profiles defined by IHE (Integrating the Health Enterprise); Clinical Portal Services that enable authorized providers and other care givers to view a personal health record via a user interface that facilitate quick and easy understanding of a patient’s health status and history while enabling easy access to detailed care information; Federal Partner Gateway Services that are certified and meet agreed integration standards for the sharing of patient information between HIEs operating in Nevada and the Federal Partners; State Agency Gateway Services (e.g., Medicaid, Immunization, etc.) that are certified and meet agreed integration standards for the sharing of patient information between HIEs operating in Nevada and the various health registries and health programs; Clinical Data Repository Services that will enable the storing of patient health information to the extent it is agreed by patients and aligned with State and Federal laws, regulations, and policies; Security Controls including authorization, authentication, access, audit, and breach reporting, and Performance Reporting Services that provide access to operational information about the HIE (e.g., numbers of messages by message type, by provider type; number of users by type, system outages, etc.). Optional elements to be implemented by the HIE Vendor include: EHR for Physician Practices; Analytic Services; Clinical Decisions Support Services; Specialist Portal Services (e.g., emergency services, urgent services, etc.); Clinical Alerts and Notifications – Providers/ACOs; NHIE Request for Proposals - HIE Vendor 2

Clinical Alerts and Notifications – Payers for Managed Care; Clinical Alerts and Notifications – Patients; and Telehealth/Telemonitoring Support Services (e.g., messaging, portals, storage of clinical data, etc.). 1.2. OVERVIEW OF HIE VENDOR SERVICES In addition to the Core HIE Solution, the selected HIE Vendor will be required to provide a series of services over a 3-5 year period of performance. These services include: System Implementation Services; Hosting Services; Administrative & Operational Support; Business Development Support; Outreach Services and Promotional Materials; Value-add HIE Solutions; and Enterprise HIE Services (optional). NHIE Request for Proposals - HIE Vendor 3

2. BACKGROUND: NHIE OPERATIONAL FRAMEWORK At its foundation, NHIE’s basis for existence derives from Nevada’s HIE vision, and the principles and values emanating from it. As context for the explanation of NHIE’s roles, responsibilities and organization relationships, the NHIE Vision and Mission statements are reiterated below. 2.1. NEVADA HIE VISION The NHIE vision continues to be to establish a sustainable State-wide HIE business that delivers an information exchange capability and encourages broad use of health information services to improve and innovate the delivery of wellness and care to individuals in the State. The information exchange capability will enable the sharing of health care data across organizational boundaries (inter- and intrastate lines) and will eventually be shared with consumers to improve patient care coordination and safety, mitigation of medical errors and reduce unnecessary and duplicate testing. The state of Nevada supports a resident population of approximately 2.7 million, with a transient population that reaches as much as 40 million or more. In addition to supporting native, resident Nevadans, the NHIE will also support this transient population that comes into the State as a result of the gaming and tourism industry. For this transient population, HIE services are essential to expedite routing and delivery of accurate information and enabling quick, timely treatment. 2.2. NEVADA HIE MISSION STATEMENT “Provide affordable and easy-to-adopt Health Information Exchange Services for the Nevada Health Care community and beyond (interstate), and encourage broad use of these services.” 2.3. PRINCIPLES AND VALUES THAT GUIDE NHIE ROLES, RESPONSIBILITIES, AND RELATIONSHIPS The HIE Vision points to foundational principles and values which guide the design of NHIE Organization Landscape Model. To be successful and sustainable, the NHIE must: Support high quality, safe, and efficient health care services through improvements in continuity of care and better information for care decisions. Promote the benefits of health information exchange and the usage of the State-wide HIE system among providers, payers and patients. Provide the individual patients with access to their health information and supporting tools that empower them to participate in their health and wellness. Ensure the privacy and security of personal health information, both stored and exchanged. Enable intra-state, inter-state, and nationwide health information exchange. Operate within a governance structure that is transparent, includes stakeholder participation, and is in compliance with all state and federal laws and regulations. NHIE Request for Proposals - HIE Vendor 4 Comment [GCY1]: This is a full extract from the NHIE Organizational Framework & Operational Guidelines document. It may be more content than is useful for a HIE Vendor, but if an objective is to find a vendor that is willing to participate in some risk/reward opportunities, then they will need to see this level of detail.

Provide equal access for underserved and rural/frontier populations as well as those in the urban areas. Deliver HIE-based information services to Medicaid providers and to the Medicaid organization for improved care delivery to the State’s Medicaid population. Deliver HIE-based information services to Nevada State agencies both within the Department of Health and Human Services (DHHS) as well as those in other State departments (e.g., Department of State, Department of Corrections, Department of Insurance). Effectively manage Cooperative Agreement resources as a one-time investment to enable longterm value for Nevadans and the Nevada health community. Establish a HIE business that is operationally and financially feasible, achievable, and sustainable. Help ensure HIE capabilities are available to enable meaningful use outcomes for health systems and providers. Facilitate adoption of health information services for Nevada patients and across relevant stakeholder organizations (e.g., hospitals, practices, payers, State agencies) across a broad range of uses and scenarios. Proactively foster innovation and adapt to emerging trends, standards and developments, both locally and nationally. 2.4. THE NEVADA HIE ORGANIZATION LANDSCAPE The model presented in Figure 1-1 depicts the major organizations of Nevada’s HIE environment and the salient relationships among them. Other than the NHIE, the organizations represented in this model are well known as key participants in the Nevada health community and patients’ value chain. NHIE Request for Proposals - HIE Vendor 5

Figure 1-1: Nevada HIE Organizational Landscape DHHS Director Internal Perspective Participates on Board NHIE Board of Directors NHIE Committees/ Workgroups Oversees NHIE Contracts to Participate NHIE Chief Executive Contracts with NHIE to Provide Services as the State HIE defined by State law. NHIE Operations Marketing & Sales Contracting & Operations HIE Technical Operations Financial Operations Human Resources etc. Contracts for Services HIE Solution Supplier(s) Certifies HIE to be able to participate Provides Consent / Subscribes for Services Certified for NwHIN Contracts to Participate NV Certified HIEs Private HIEs Hospital HIEs Certified Participants Care Organizations (Hospital, Practices, etc.) Ancillary Health (Laboratories, Radiology Centers) Provides Consent Consumer/Patient Federal Partners (ONC, CDC, CMS, VA, etc.) Commercial Payers Sponsors Nevada HIE Contract to Participate in Nevada HIE Industry Sectors State State State Agency State Agency Agency Agency OR Other Suppliers State Virtual HIE State State State Agency State Agency Agency Agency By statute, the NHIE Board, under direction of the DHHS Director, will be the “governing body” for health information exchange in Nevada as well as a HIE service provider to patients and health organizations. The NHIE Executive Director will lead the NHIE Corporation, which is the “governing entity” as defined in statute. Relationships among HIE organizational components will be controlled by combination of statute, policy, regulation, contractual agreement, and participation agreement. The organizations and the formalization of their relationships amongst each other will be used to execute the Nevada HIE mission. Key elements of that mission are to realize: Compliance with Federal laws, regulations, and policies, Compliance with Nevada State statutes and regulations, Advancement of the NHIE goals and objectives, and Achievement of the vision for Nevada HIE. The sections that follow provide a description of the operational-level responsibilities, relationships, and accountabilities of the organizational entities existing in the Nevada Health Information Exchange (NHIE) landscape. These include the following major organizational entities: DHHS Director, NHIE Board of Directors and its Workgroups and Committees, the NHIE Non-Profit Operating entity, and “customers”/stakeholders (patients) of NHIE. NHIE Request for Proposals - HIE Vendor 6


Enable intra-state, inter-state and nationwide health information exchange; Provide for a centralized consumer/patient consent management capability; Facilitate two way exchanges of information between the health community and the State of Nevada departments and agencies supporting Nevadans' health (e.g., DFHS of Medicaid care

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